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Caseous Mitral Annular Calcification — EECC MCQ

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HardCardiac ImagingCaseous Mitral Annular CalcificationEECC

A 65-year-old man presents with exertional dyspnoea. Echocardiography shows a large, immobile, calcified mass in the posterior mitral annulus extending into the submitral apparatus. There is mild MS (MVA 1.8 cm²) and mild MR. The mass is echodense with acoustic shadowing. What is the most likely diagnosis?

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Correct answer: A — Caseous calcification of the mitral annulus — a variant of mitral annular calcification (MAC) that can mimic a cardiac tumour or abscess

Caseous calcification of the mitral annulus (caseous MAC) is a recognised variant of mitral annular calcification, characterised by a round or oval echodense mass with central liquefaction (echolucent centre) and peripheral calcification with acoustic shadowing. It is typically found in the posterior mitral annulus and can mimic cardiac tumours or abscesses on echocardiography. CT shows a calcified mass with a central hypodense area. It is generally benign but can contribute to MS or MR depending on extent. The diagnosis is important because: (1) it avoids unnecessary surgery for presumed tumour; (2) it is distinguished from abscess by the clinical context (no fever, negative blood cultures). Rarely, it can embolise.

Reference: EACVI/ASE Echocardiography Guidelines